BPD MRI Studies, Cause & Effect

[JQ]

Hi group,

Cause and effect ... .Ok so I just had an in-depth conversation with a Clinical Therapist friend of mine who has & continues to treat BPD among patients. In all of our conversations we've had over the subject she among other in the mental health field have suggested to me & others that his is a pure environmental condition. That any brain physical abnormality is NOT a part of the BPD or other mental health conditions. In fact, in her clinical professional life, the physical abnormality isn't even discussed much less known about when asked.

I was told that in her advance education, all the symposiums, co-worker conversations that not one time did brain abnormality studies come up in discussion. I suggested to them that in all of our conversations that you only speak of "Treating The Effect" of BPD & not the cause of it. Not once have I ever heard you discuss other than a serious repeated trauma is the cause of BPD.  Mental Health Professionals are only treating the effect of the mental illness & not the cause. It's like a heart doc treating symptoms of heart attack but not treating the cause which is blocked arteries.

I also suggested that multiple studies have evidence that suggest that it is a genetic or inheritable physical abnormality brains from parent to child.

FYI, DBT’s primary interventions—such as skills training in emotion regulation and a straightforward approach to dysfunctional behaviors. This is treating the effect and not the cause of the condition.

So I offer these studies of MRI on the brain for your reading & your thoughts on all of it. Open respectful discussion on the results of respected institutions studies. For those who want to know how I obtained these, I went to Google and typed in, "BPD MRI brain scans


National Institute of Health - 24 Feb 2012,

Compared with HC, BPD subjects had significant bilateral reductions in gray matter concentrations in ventral cingulate gyrus and several regions of the medial temporal lobe, including the hippocampus, amygdala, parahippocampal gyrus, and uncus. BPD women (and abused BPD women), but not BPD men, had significant reductions in medial temporal lobe, including the amygdala. BPD men, but not BPD women, showed diminished gray matter concentrations in the anterior cingulate gyrus compared with findings HC.

 www.ncbi.nlm.nih.gov/pmc/articles/PMC3286221/

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Structural brain abnormalities in borderline personality disorder: 30 Dec 2008

Compared with HC, BPD subjects had significant bilateral reductions in gray matter concentrations in ventral cingulate gyrus and several regions of the medial temporal lobe, including the hippocampus, amygdala, parahippocampal gyrus, and uncus. BPD women (and abused BPD women), but not BPD men, had significant reductions in medial temporal lobe, including the amygdala.
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From the National Health Science in the UK. */22/2016

There's no single cause of borderline personality disorder (BPD) and it's likely to be caused by a combination of factors. But things like Genetics, brain abnormalities brain chemicals aka hormones are just part of it.

www.nhs.uk/Conditions/Borderline-personality-disorder/Pages/Causes.aspx
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From Current Psychiatry, Dr. Henry Nasarallah M.D. 13 April 2013,

References 42 studies to show how the brain is abnormal in those with BPD vs a control group that do not. Genetic Studies
There is substantial scientific evidence that BPD is highly heritable—a finding that suggests that brain abnormalities of this disorder are a consequence of genes involved in brain development (similar to what is known about schizophrenia, bipolar disorder, and autism). A systematic review of the heritabil­ity of BPD examined 59 published stud­ies that were categorized into 12 family studies, 18 twin studies, 24 association studies, and 5 gene-environment inter­action studies.3 The authors concluded that BPD has a strong genetic compo­nent.

The neuropsychiatric basis of BPD must guide treatment
There is no such thing as a purely psycho­logical disorder: Invariably, it is an abnor­mality of brain circuits that disrupts normal development of emotions, thought, behavior, and social cognition. BPD is an exemplar of such neuropsychiatric illness, and treat­ment should support psychotherapeutic ap­proaches to mend the mind at the same time it moves aggressively to repair the brain.

www.currentpsychiatry.com/the-publication/issue-single-view/borderline-personality-disorder-is-a-heritable-brain-disease/3bc96d9e33065b76fd114fcd15566bde.html
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From the NIMH, 2 Oct 2008

Differences in the working tissue of the brain, called grey matter, have been linked to impaired functioning of an emotion-regulating circuit in patients with borderline personality disorder (BPD).

The imaging studies are the first to link structural brain differences with functional impairment in the same sample of BPD patients. Similar changes in the same circuit have been implicated in mood and anxiety disorders, hinting that BPD might share common mechanisms with mental illnesses that have traditionally been viewed through the lens of biology.

www.nimh.nih.gov/news/science-news/2008/emotion-regulating-circuit-weakened-in-borderline-personality-disorder.shtml
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Mayo Clinic,

Genetics. Some studies of twins and families suggest that personality disorders may be inherited or strongly associated with other mental disorders among family members.
Brain abnormalities. Some research has shown changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function prope

[JQ]

Group,

the point of me posting this was that I see so many here trouble by BPD from a loved one. They struggle with how to fix them, cure them, treating them. I see time and time again so many who ask questions like, "o they get better?" "Will he or she come back" "Why don't they love me?" "Why are they with my replacement?" Will they ever understand how much I love them". Did they ever really love me?" ... .etc etc etc.

They struggle with the whole situation & want to get back to that Idealization stage of the relationship & as we have learned that is very much unlikely to happen. SO then we struggle with trying to get them to understand how much we care & love them and we just want to give them what they want but because of their inability to comprehend all of it they push us away. They have impulse control issues with drugs alcohol, drugs, sex, etc. & this is found to be part of the abnormal brain found in so many scans.

I see so many NONs on the boards agonize day after day about their respective BPD & how they can get them back. "Is there any hope left", "What are boundaries & how do they help", "How do I get them back when I've been replaced." and the list goes on and one and on. There are decades of examples after examples posted in these forums asking  "how to get a BPD back in their life."

There is a lot of discussion on DBT therapy but if we're being honest here at best it's a way for a BPD to attempt some sort of limited behavioral modification of impulse control, behavioral control, etc. The NON has to accept to a degree that there will always be issues & there is no silver bullet. In other words there is NO cure. How can their be a cure when so many studies, people with decades of study & education, Ph.d's, MDs, etc. have discovered that there are actual physical abnormalities within the BPD brain.  In addition to physical abnormalities there are hormones other brain chemicals to toss into the mix in addition to the actual repeated trauma & other environmental conditions to create this broken brain that is currently beyond modern science to repair or to cure.

I understand from personal experience on several levels how BPD can tear a person apart. I understand how they can blame themselves for saying or not saying something or doing or not doing something. I know how it is to agonize over a choice of words or how you could have done something different so as not to make them rage or leave, or dysregulate, etc etc etc.

If you can't change them because they are actually physically broken, then the alternative is to look at yourself and ask what can I change about myself. Look deep at your past, your history & ask yourself the tough questions that are hard to answer. Get a good therapist to help you work through the pain, heartache. Those of us who have will tell you that it is required to help you get to the other side of the BPD canyon. You don't have to be honest with anyone here in the group but YOU have to be honest with yourself at the end of it all. As tough as it is you have to look yourself in the mirror and tell yourself you need to move on and learn to live YOUR life for YOURSELF. This group in part helped me get there. It was part of the solution to get to a better place in my life. It sucks, it hurts, it can be the worst moment of your life but you have no where to go but up when you start the process of healing yourself. To learn to live your life to the fullest.

IMHO

J

[schwing]

Hi JQ,

I find this information fascinating. Thank you for sharing.

When comparing brain scans of adults with and without BPD, I wonder if the differences observed in brain anatomy could not very well be the "effect?"  I wonder if the "reductions" in the hippocampus (limbic system/related to the processing of emotions; consolidations of memory), amygdala (memory, decision-making, emotional reactions), parahippocampal gyrus (memory encoding) and uncus, are not a result of disuse or disrupted use of these parts of the brain.

Consider for example the reduction in the occipital lobe (visual processing) of someone who is blind vs. someone who is sighted; in this case, is the problem neurological? Obviously not.  And I would argue that the observation that adult BPD brains show differences does not necessarily mean that the "cause" is neurological.

Assuming that borderline personality disorder begins in early childhood development, I wonder what differences might be revealed between children with and without BPD.  Can we even diagnose BPD at that stage of development?

Let's assume for argument's sake that the problem is neurological. That there might be some disease process going on that affect these key (and very deep) parts of the brain. What kinds of treatment methods might be considered?

Consider a patient who is a productive member of society, but when it comes to close interpersonal relationships he/she experiences some distress; would this person be willing to undergo medical procedures directly treating the brain?  What are the risks/benefits?

Do we have any medications that can target specific parts of the brain?  To my knowledge our medicines seem only to affect neurotransmitters and the body's metabolism of these neurotransmitters (which more or less affects the entire body's nervous system and not just a targeted section).

My 2 bits,

Schwing

[JQ]

  schwing

Thank you for the questions and feedback.  There are studies after studies, MRI, Genomic, etc. and these links are for all to explore, read, educate and ask questions after they do the research to the questions they have on their respective BPD r/s.  The ones I posted are just a handful of them. These handful of sites & statements are not to answer all questions or "Be all End All of BPD questions", but instead to stimulate others to conduct their own research & studies, read & learn for themselves about what is going on in the world of science when it comes to this horrific Behavioral Mental Illness.

I was surprised that my Clinical Therapist friend, their Co-workers & others at symposiums do NOT even bring up the discussion of brain abnormalities when they conduct BPD & other PD discussions. In fact they weren't even aware that MRI brain scans were being conducted by some of the worlds leading learning institutions. I consider this an injustice to themselves, the men & woman in the professional of Mental Health Field and most certainly to the BPD & other PD patients they are suppose to serve.

IMHO

J

[JQ]

Group,

In addition I would like to thank Skip & all the others here providing this forum, especially this forum to learn, explore, exchange ideas and certainly to help our fellow NONs in an attempt to get to a better place in reference to our own BPD r/s. We are codependents and if we are to get to a better place, then we have to learn about ourselves and why we are the codependents that we are.

As I've explained before, this group in this forum of "etaching from the Wounds" are codependents is very much like be an alcoholic. A alcoholic will always be one & will need a lifetime of support from other alcoholics in meetings like AA in order to stay sober. I am a codependent and I will always be a recovering codependent & these forums will be where I come to get the support & assistance of being a "recovering codependent." Hi my name is Bob & I am a codependent ... .& the congregation in unison says, "Hi Bob".  

We support each other in guidance on how to maintain NC, LC or give a brother or sister some support when they come to the group asking for help because they've received a text, a call, an email from their respective pwBPD & don't have the strength to maintain NC/LC or don't know how to handle a situation that involves their children, parents, or their beloved dog. We're there to just be there ... .no passing of judgement ... .just support.

Thank you Skip & the others here that give us the "meeting room" for our BPD Anonymous group and the support from others to further the healing process of moving forward for ourselves. I suggested in one comment that we should have a "imogi" for 30 days NC, 6 months NC and annual there after kinda like the AA coins you get at the meetings.    Perhaps their should be another room / forum named "BPD Anonymous Meeting Room" or rename this one.

I wish you all well & continued smooth roads on your journey

J

[Skip]

In all of our conversations we've had over the subject she among other in the mental health field have suggested to me & others that his is a pure environmental condition.

The literature is pretty clear that genetic predisposition is a significant part of this disorder.

The neurophysiology, however, is not well understood as your citations point out. It is being studied and we should expect that this will eventually sort out, but it is in the early stages. There are a number of studies and hypotheses being pursued by neurophysiologists - but this is largely research.

What is the practical utility of that to a treating clinician in 2016? I'm not sure much other than we are seeing psychiatrists more aggressively applying pharma-therapeutics.

What is the practical utility of the state of BPD neurophysiology to us on the detaching board?

Personally, I struggle to see any. To a parent, its a pretty big question. To a spouse, it might be a avenue  to explore. To an ex partner?

Don't get me wrong. I think it is really helpful to understand BPD. It helps us answer a lot of the behavioral patterns. More importantly, after dissecting our ex, we have typically read enough psychology that we can turn the scalpel on ourselves - use the research tools we learned to start understanding our own behavior. Is everyone on this board a "codependent"? Do we all have "PTSD". Are we all substance abusers?  :)o we all operate clinical levels of narcissism? OCD?

The answer is obviously no - we are not all the same - but many of us have behavioral patterns rooted in one or more of those things (or something else) and we need to start looking at ourselves more carefully - help each other do this complex self investigation.

Why? So we can become mindful and  make our own behavioral modifications and/or seak professional care.

We no longer have our exs to contend with. We do and will still have ourselves to contend with.  

[enlighten me]

As skip said how will this infirmation help. At the moment for me it provides a greater understanding of my exs behaviours. It also helps with detatching by knowing there is nothing I can do.

What does the future hold. Short of genetically modified babies to remove the genetic predisposition I cant see much. The brain is a vastly complex machine the depths of which are a long way from being understood. Tweaking one bit will affect another and the knock on effect is unknown. PwBPD already regulate in their own way. They have had years of doing this and havent perfected it. Emotions change brain chemistry and how that effects the BPD brain isnt understood. A pill would have to constantly balance ever changing emotions so short of sedation it would be nigh on impossible.

Targetting of affected areas may eventually produce results but I dont think I will be around to see it. 

As JQ stated I too get infuriated by the way the symptoms rather than the cause is the main focus. If you car has a fault you want to know what causes it not what will get around it so it can function.

[Skip]

I too get infuriated by the way the symptoms rather than the cause is the main focus. If you car has a fault you want to know what causes it not what will get around it so it can function.

Who are you infuriated with? The physiologists for not waiting for the neurobiologists to figure this out and the pharmaceutical companies to discover an agent to alter the condition?

It would be great to have better science - but as you say, that is not a 2016 thing.

The risk of focusing on the biology of BPD, for us as a support board for detaching, is that its really a diversion from that tangible things that can be done in the here and now.

We should put our energies in learning more about basic human behaviors (a lot of us live with expectations set by Hollywood), basic human behavioral dysfunctions, and effective relationship skills.

This is where many of us are weak in our knowledge.

[Icanteven]

It's like a heart doc treating symptoms of heart attack but not treating the cause which is blocked arteries.

I thought a lot about this analogy, and I don't think it quite fits.  Based on all the literature you cited, BPD appears to be more like a cardiologist dealing with a patient that has a faulty mitral valve: sometimes a combination of medications and exercise and diet is enough to achieve the desired results; sometimes you have to replace the valve itself.

Unfortunately, we can't replace the defective brain structures, and not only that - to extend your analogy - we're in the 1950's of cardiology when it comes to the current brain science of mental illness.

It would be great to have better science - but as you say, that is not a 2016 thing.

This is something that's weighed a lot on me this week.  I ran into a psychiatrist friend this week who was asking me how things were going, and a few really chilling points came up:

1)  "Remember ICE, if this were 100 years ago the two of you never even met because she would have almost certainly been institutionalized;"
2) "Remember too, we didn't know what we didn't know about antidepressants; that's why the cheek swab is gaining ground; turns out Zoloft doesn't work for a lot of people because their body chemistry doesn't absorb certain nutrients, so they'd be on Zoloft and it wasn't working and we'd switch but we were making educated guesses; now we do a swab and place them on Zyban from day one and avoid all that; we didn't know that a decade ago; "
3) "Remember finally, you guys are beneficiaries of privilege in that you have Cadillac insurance and a big, extended support network; were your wife born poor or even middle class without relatives to help she very well may be institutionalized NOW; hell, she just about was anyway; the specialists she's seeing don't take Medicaid, nor do the brand name centers she's been in, so she'd just be waiting to have an episode that triggered psychiatric hospitalization or worse."

Regardless of the interplay between nature and nurture, as you say Skip, there are things that can be done in the here and now, I just get the impression that even the mental health community isn't always on the same page - at least in terms of the most up to date information - when it comes to BPD.

[enlighten me]

  Skip

what infuriates me is how dismissive some psychitrist are that it could be neurological. I have read numerous things from psychitrists who are unwavering in their belief that BPD is caused in childhood. No matter what evidence is given. I am willing to see the plausability that nature and nurture can cause it but some proffessionals arent willing to even consider it.

It reminds me of the longitude problem where a carpenter from yorkshire called Harrison produced a time piece that could help to predict your longitude to a matter of minutes. The establisment who where basically the royal astronomical society would not accept him as having solved the problem because they believed the answer lay in the stars. The reward for solving the problem was a small fortune which Harrison never saw. It was latrr given to his son as a posthumous reward.

At times it feels like two sides arguing that they are right rather than combining their skills Even if neurology is the key I still believe that therapists will be needed to change a lifetime of habits and thinking. Just because you get a new hand doesnt mean you dont need a physio to train you to use it.